Automation helps insurers manage complaints from end to end

Thomas Harrington,

You’ve heard this before: Today’s digitally-savvy and connected customers expect fast, accurate, and personalized service. And although insurers are leveraging digital technologies to market to consumers or connect on the front end, the truth is many organizations’ back-end processes are still a jumble of manual files, siloed knowledge, bespoke applications, and disparate systems of record – roadblocks to providing the type of service that consumers want. This challenge often becomes acutely clear when a policyholder has some sort of complaint.

According to the U.S. National Association of Insurance Commissioners, the organization that tracks consumer complaints to state insurance departments, consumer complaints are on the rise. Claims denials, promptness of payments, underwriting challenges, renewals and policyholder service issues are all potential sources of customer dissatisfaction.

A complaint is a key moment of truth for any insurance carrier

Customer discontent can create wide ranging and adverse economic effects for carriers. How an insurer manages customer complaints has economic and organizational impacts for brand image and reputation, customer retention, regulatory compliance, and the bottom line. Just factor in the amount of time and resources needed to investigate a complaint and manage in accordance with regulatory requirements. Then add in the potential costs for potential legal action, fines, and customer attrition … and don’t forget the damage to a carrier’s image when a customer tweets and posts about terrible service or how long it took to be reimbursed for the gaping hole in their roof. It’s in the carrier’s and the customer’s best interest to have processes in place that help review and resolve a complaint quickly.

Operational issues can increase a customer’s frustration with service

To resolve a complaint, insurers typically need to understand the customer’s history and the details of the complaint, then assign work to the best staff to handle the carrier’s response. They also need to understand the value of the relationship, how to respond to a complaint, and the best channel in which to do that. Plus, all of these data, decisions, and actions need to be trackable and auditable. It’s complex work. And poor operational processes can exacerbate that complexity. But there are ways to use digital technologies to improve the complaints process.

Omni-channel capabilities, intelligent automation, and case management are three key technologies that help streamline complaint processes

On an enterprise scale, a complaints process involves a number of steps and actors. What was once a strictly back-office process has evolved, requiring carriers to connect both the front- and back-offices to drive toward a resolution. Working together as part of a unified complaints solution, carriers can leverage omni-channel, intelligent automation, and case management capabilities to help manage complaints quickly and accurately:

  • Intake: Carriers should be ready to intake a complaint anytime, anywhere, on any channel. Omni-channel systems make it possible to support communication via phone, web, chat, email, self-service, and white mail, as well as other digital devices. Intelligent automation helps verify data, assemble relevant customer history and data, and guide staff on next steps to take.

  • Investigate / Assign: Intelligent automation and dynamic case management are used to review the severity of complaint, solve with an automated set of procedures (if appropriate), or swiftly route to appropriate staff for further action.

  • Intervene / Resolve: Case management orchestrates the activities and tasks from end to end, automating escalations or remediation, enabling collaboration, and closing out the complaint.

  • Correspondence: Intelligent automation and case management can be used to trigger automated confirmation via preferred or required channels.

  • Insight / Reporting: Case management captures all actions and correspondence as part of an audit trail. Intelligent automation can trigger pre-built reports or indicate if custom reports are needed.

Together, working as a unified solution, these technologies can help carriers efficiently and effectively drive complaint resolution across varied resources and systems. And because case management is capturing relevant data and actions for every step of the process, organizational leaders have visibility into any trends, patterns, or areas that need improvement.

The same technologies that streamline the complaints processes may help insurers actually reduce complaints

Of course, the best way to improve complaints resolution is to try to avoid actions that prompt a complaint altogether! Using a unified complaints solution with built-in, automated rules and defined processes, carriers have more power to enforce complaints policy compliance and best-practice handling processes across lines of business, channels, and jurisdictions – an important step toward reducing the likelihood of outcomes that don’t meet enterprise or regulatory policies. Finally, the ability to define and change business rules gives carriers the ability to adapt to constantly changing regulatory requirements.

Beyond cost savings, the most important reason to adopt a unified approach to complaints is because insurance carriers should be recognized for helping customers replace and rebuild lives after an event, not for contributing to the customer’s frustration.

Learn more:


  • Industry: Insurance
  • Topic: Customer Service
  • Challenge: Customer Service
  • Product Area: Customer Service

About the Author

In his role as Global Industry Markets Leader for Insurance at Pega, Thomas Harrington works with leading organizations to drive performance, customer experience, and revenue growth through digital transformation.